Department of Emergency Medicine, Summa Akron City Hospital, Akron, Ohio 44304, USA.
Prehosp Emerg Care. 2013 Apr-Jun;17(2):203-10. doi: 10.3109/10903127.2012.755585. Epub 2013 Feb 12.
Identifying ST-segment elevation myocardial infarctions (STEMIs) by paramedics can decrease door-to-balloon times. While many paramedics are trained to obtain and interpret electrocardiograms (ECGs), it is unknown how accurately they can identify STEMIs.
This study evaluated paramedics' accuracy in recognizing STEMI on ECGs when faced with potential STEMI mimics.
This was a descriptive cohort study using a survey administered to paramedics. The survey contained questions about training, experience, and confidence, along with 10 ECGs: three demonstrating STEMIs (inferior, anterior, and lateral), two with normal results, and five STEMI mimics (left ventricular hypertrophy [LVH], ventricular pacing, left and right bundle branch blocks [LBBB, RBBB], and supraventricular tachycardia [SVT]). We calculated the overall sensitivity and specificity and the proportion correct with 95% confidence intervals (CIs).
We obtained 472 surveys from 30 municipal emergency medical services (EMS) agencies in five counties with 15 medical directors from seven hospitals. The majority (69%) reported ECG training within the preceding year, 31% within six months; and 74% were confident in recognizing STEMIs. The overall sensitivity and specificity for STEMI detection were 75% and 53% (95% CI 73%-77%, 51%-55%), respectively. Ninety-six percent (453/472, 95% CI 94%-98%) correctly identified the inferior myocardial infarction (MI), but only 78% (368/472, 94% CI 74%-82%) identified the anterior MI and 51% (241/472, 46%-56%) the lateral MI. Thirty-seven percent (173/472, 95% CI 32%-41%) of the paramedics correctly recognized LVH, 39% (184/472, 95% CI 35%-44%) LBBB, and 53% (249/472, 95% CI 48%-57%) ventricular pacing as not a STEMI. Thirty-nine percent (185/472, 95% CI 35%-44%) correctly identified all three STEMIs; however, only 3% of the paramedics were correct in all interpretations. The two normal ECGs were recognized as not a STEMI by 97% (459/472, 95% CI 95%-99%) and 100% (472/472, 95% CI 99%-100%). There was no correlation between training, experience, or confidence and accuracy in recognizing STEMIs.
Despite training and a high level of confidence, the paramedics in our study were only able to identify an inferior STEMI and two normal ECGs. Given the paramedics' low sensitivity and specificity, we cannot rely solely on their ECG interpretation to activate the cardiac catheterization laboratory. Future research should involve the evaluation of training programs that include assessment, initial training, testing, feedback, and repeat training.
通过护理人员识别 ST 段抬高型心肌梗死（STEMI）可以缩短门球时间。虽然许多护理人员接受过获取和解读心电图（ECG）的培训，但尚不清楚他们能够多准确地识别 STEMI。
本研究评估了护理人员在面对潜在 STEMI 模拟时识别 ECG 上 STEMI 的准确性。
这是一项描述性队列研究，使用向护理人员发放的问卷调查进行。该调查包含有关培训、经验和信心的问题，以及 10 份 ECG：三份显示 STEMI（下壁、前壁和侧壁），两份显示正常结果，五份 STEMI 模拟（左心室肥厚 [LVH]、心室起搏、左束支和右束支传导阻滞 [LBBB、RBBB] 和室上性心动过速 [SVT]）。我们计算了总体敏感性和特异性以及 95%置信区间（CI）内的正确比例。
我们从五个县的 30 个市紧急医疗服务（EMS）机构获得了 472 份调查，其中有来自七个医院的 15 名医疗主任。大多数（69%）报告在过去一年中接受了 ECG 培训，31%在过去六个月内接受了培训；并且 74%对识别 STEMI 有信心。STEMI 检测的总体敏感性和特异性分别为 75%和 53%（95%CI 73%-77%，51%-55%）。96%（453/472，95%CI 94%-98%）正确识别了下壁心肌梗死（MI），但只有 78%（368/472，94%CI 74%-82%）正确识别了前壁 MI，51%（241/472，46%-56%）正确识别了侧壁 MI。37%（173/472，95%CI 32%-41%）的护理人员正确识别 LVH，39%（184/472，95%CI 35%-44%）识别 LBBB，53%（249/472，95%CI 48%-57%）识别心室起搏不是 STEMI。39%（185/472，95%CI 35%-44%）正确识别了所有三个 STEMI；然而，只有 3%的护理人员在所有解释中都是正确的。这两个正常的 ECG 被 97%（459/472，95%CI 95%-99%）和 100%（472/472，95%CI 99%-100%）的护理人员识别为不是 STEMI。培训、经验或信心与识别 STEMI 的准确性之间没有相关性。
尽管接受了培训并且信心很高，但我们研究中的护理人员仅能够识别下壁 STEMI 和两个正常 ECG。鉴于护理人员的敏感性和特异性较低，我们不能仅仅依靠他们的 ECG 解释来激活心脏导管插入术实验室。未来的研究应包括评估培训计划，包括评估、初始培训、测试、反馈和重复培训。
